Laparoscopic surgical clamp

ABSTRACT

A surgical clamp includes a first jaw having a proximal end and a distal end, and a pawl secured to the first jaw near the proximal end. The pawl is biased in a proximal direction via a leaf spring. The surgical clamp further includes a second jaw having a proximal end and a distal end. The second jaw is adapted for being pivotally secured to the first jaw, and includes a ratchet disposed proximally relative to the pawl and in mesh with the pawl when the second jaw is secured to the first jaw. The surgical clamp further includes a movable member secured to the first jaw, which is adapted for contacting and moving the pawl in a distal direction against the bias of a leaf spring to thereby move the pawl out of mesh with the ratchet. The first jaw and the second jaw are movable from a closed state to an open state when the pawl is moved in the distal direction by the movable member. The pawl is adapted to be biased back into mesh with the ratchet when the movable member is removed from contact with the pawl.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation-in-part of U.S. patent applicationSer. No. 08/674,925, filed on Jul. 3, 1996; which is acontinuation-in-part of U.S. patent application Ser. No. 08/139,919,filed on Oct. 20, 1993, and now issued as U.S. Pat. No. 5,496,333.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates generally to surgical clamp apparatus and morespecifically to clamps and clamp appliers for use in occluding bodyconduits.

2. Description of Related Art

Alternatives to large incision, open surgery are becoming increasinglyimportant where they can provide reduced trauma and an increased speedof healing. For the patient, this ultimately equates to less time in thehospital which adds the economic advantage to these procedures.

Surgeries in the abdominal area are now being undertaken with atechnique commonly referred to as laparoscopic surgery. In thisprocedure, access devices are used to puncture the abdominal wall orlapra and to provide working channels for instruments to perform thesurgery. These access devices, commonly referred to as trocars, requirerelatively small incisions and provide working channels in a range ofdiameters between, for example, 5 mm and 21 mm.

Typical of these access devices is the trocar disclosed and claimed inapplicant's patent U.S. Pat. No. 5,209,737 issued on May 11, 1993 whichis incorporated herein by reference.

Since the objectives of the open surgeries and laparoscopic surgeriesare often the same, it is not surprising that the occluding of bodyconduits is still of interest. However in the case of laparoscopicsurgeries, this can be accomplished only with considerable difficultydue to the limited access provided by the trocars. Also, the confinedabdominal cavity associated with laparoscopic surgeries generallyrequires additional retraction of organs in order to provide an enlargedsurgical field.

Surgical clamps of the past have been adapted for open surgery whereinthe size of the clamp is not constrained by the inside diameter of atrocar. These clamps commonly include long legs which form the jaws ofthe clamp and opposing smaller arms which are pivotal with the legs on afulcrum disposed therebetween. These clamps are typically operable by aclamp applier which has a scissor configuration. The scissors of theapplier in an open state engage the arms of the clamp and compress thosearms to open the legs of the clamp. Unfortunately, with thisconfiguration, either the long legs of the clamp are spread or thescissors are spread. In either case, this combination is not adapted foruse with the narrow diameters offered by laparoscopic trocars.

The engagement mechanisms associated with these clamp systems of theprior art are also inappropriate for laparoscopic surgery. In the past,the clamp applier loosely engaged the clamp; this presented no problemto open surgery where one could merely reach into the cavity andretrieve a loose clamp. However, in laparoscopic surgery, the relativelyclosed surgical environment cannot tolerate this possibility ofundesirable separation of the clamp from the applier.

SUMMARY OF THE INVENTION

These disadvantages of the prior art are overcome with the presentinvention which includes a novel surgical clamp and associated clampapplier both of which are insertable through a trocar. The clamp isprovided with an elongate cylindrical configuration having an axisextending between a proximal end and a distal end. The clamp has twojaws which are relatively movable between an open state and a closedstate. One jaw may be formed as an extension of a supporting structureat the proximal end of the clamp, while the other jaw is pivotal oneither the supporting structure or the one jaw.

A first jaw has a movable set of teeth located near a proximal end ofthe first jaw, and a second jaw has a fixed set of teeth located near aproximal end of the second jaw. A slot is formed within the first jawfor accommodating an external pin. The slot is formed between a fixedmember and a movable member. The movable set of teeth is connected tothe fixed member, and a contacting protrusion is secured to the movablemember. The movable set of teeth is normally biased against the fixedset of teeth via a leaf spring, which is also connected to the fixedmember. When the movable set of teeth and the fixed set of teeth aremeshed together, the two jaws are prevented from moving in a givendirection. Application of a force by the external pin, however,disengages the movable set of teeth from the fixed set of teeth, andthereby allows for movement of the first and second jaws in the givendirection.

The clamp applier includes a housing and an elongate tube which is sizedand configured to move through the trocar. The clamp applier alsoincludes an engagement mechanism having a hook which can be advanced toengage the annulus of the clamp. Retraction of the engagement mechanismmoves the clamp into a rigid operative position on the applier. Biasingmeans and locking means cooperate to retain the clamp in the operativeposition. In this operative position the engagement mechanism can bemoved along a line, which is substantially perpendicular to an axis ofthe elongated tube, to thereby engage and disengage the movable and thefixed sets of teeth of the surgical clamp.

In one aspect of the present invention, a surgical clamp has first andsecond opposed jaws movable between an open position and a closedposition. A ratchet and pawl assembly is connected to the two jaws, andis adapted for allowing relative rotational movement of the two jaws ina first direction, while preventing relative rotational movement of thetwo jaws in a second direction. Movement of the two jaws in the seconddirection is accomplished by disengaging the pawl from the ratchet. Thisdisengagement function is performed by the engagement mechanism of theapplier. A pin, which is connected to the distal end of the engagementmechanism, is movable along a line approximately perpendicular to theaxis of the tube. Movement of the pin in a downward direction results inthe ratchet and pawl sliding upon one another, and movement of the pinin an upward direction results in disengagement of the pawl from theratchet wheel. Additionally, movement of the pin in the downwarddirection applies a force to the first jaw to thereby move a distal endof the first jaw toward a distal end of the second jaw. Movement of thepin in an upward direction, on the other hand, applies a force on thefirst jaw, which moves the distal end of the first jaw away from thedistal end of the second jaw. This open state allows the surgical clampto accept a body conduit.

In another aspect of the invention, a surgical clamp has a longitudinalaxis extending between a proximal end and a distal end, and includes asupporting structure. A pair of jaws is coupled to the supportingstructure, and is movable between an open position and a closedposition. A moving apparatus carried by the supporting structure isoperable from near the proximal end of the clamp between threeconfigurations. The first configuration allows a pawl of the first jawto be biased into mesh with a ratchet of the second jaw, and a secondconfiguration moves the pawl so that the pawl is no longer biased intomesh with the ratchet. In the third configuration, the first and secondjaws can be moved between both the open position and the closedposition. The surgical clamp combination further includes a clampapplier having a longitudinal axis extending between a proximal end anda distal end, and a tube disposed at the distal end of the clampapplier. An engaging apparatus is disposed within the tube for engagingthe moving apparatus at the proximal end of the clamp. The engagingapparatus is adapted to both selectively engage and disengage theratchet and pawl assembly, and is also adapted to apply forces onto thesurgical clamp to facilitate movement of the pair of jaws between theopen position and the closed position. An operating apparatus isdisposed at the proximal end of the clamp applier for operating theengaging apparatus to move the jaws of the clamp.

In another aspect of the present invention, a surgical clamp includes afirst jaw having a proximal end and a distal end, and a pawl secured tothe first jaw near the proximal end. The pawl is biased in a proximaldirection via a leaf spring. The surgical clamp further includes asecond jaw having a proximal end and a distal end. The second jaw isadapted for being pivotally secured to the first jaw, and includes aratchet disposed proximally relative to the pawl and in mesh with thepawl when the second jaw is secured to the first jaw. The surgical clampfurther includes a movable member secured to the first jaw, which isadapted for contacting and moving the pawl in a distal direction againstthe bias of a leaf spring to thereby move the pawl out of mesh with theratchet. The first jaw and the second jaw are movable from a closedstate to an open state when the pawl is moved in the distal direction bythe movable member. The pawl is adapted to be biased back into mesh withthe ratchet when the movable member is removed from contact with thepawl. The movable member is adapted for moving from a firstconfiguration into a second configuration in order to move the pawl inthe distal direction, and the movable member is further adapted forsubsequently moving from the second configuration into a thirdconfiguration in order to move the first jaw and the second jaw from theclosed state to the open state. The movable member is also adapted formoving from the third configuration back into the first configuration inorder to move the first jaw and the second jaw from the opened state tothe closed state.

The present invention, together with additional features and advantagesthereof, may best be understood by reference to the followingdescription taken in connection with the accompanying illustrativedrawings.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a perspective view of a clamp being applied by a clamp applierthrough a trocar to occlude a body conduit;

FIG. 2 is a axial cross-section view of one embodiment of the clampillustrated in FIG. 1;

FIG. 3 is a axial cross-section view of one embodiment of the clampapplier illustrated in FIG. 1;

FIG. 4 is a axial cross-section view of the applier showing a rotatableshaft deployed to an extended position;

FIG. 5 is a radial cross-section view taken along lines 5--5 of FIG. 3;

FIG. 6 is a perspective view of the clamp aligned for engagement by therotatable shaft of the clamp applier;

FIG. 7 is an elevation view of the proximal end of the clamp taken alonglines 7--7 of FIG. 4;

FIG. 8 is an elevation view of the distal end of the clamp applier takenalong lines 8--8 of FIG. 4;

FIG. 9 is a side view, partially in phantom, of the clamp operativelydisposed on the clamp applier, and a handle operated to close the clamp;

FIG. 10 is a side view partially in phantom similar to FIG. 9 with thehandle operated to open the jaws of the clamp;

FIG. 11 is a perspective view of the abdominal cavity illustrating theplacement of outer clamps in a bowelectomy procedure;

FIG. 12 is a perspective view similar to FIG. 11 showing the placementof inner clamps in the procedure;

FIG. 13 is a perspective view similar to FIG. 11 illustrating theremoval of a bowel section from the abdominal cavity;

FIG. 14 is a perspective view similar to FIG. 11 illustrating thesuturing of the bowel following removal of the bowel section;

FIG. 15 is a perspective view of a second embodiment of the surgicalclamp;

FIG. 16 is a partially exploded view of the surgical clamp of the secondpreferred embodiment;

FIG. 17 is a cross-sectional view of the clamp applier according to asecond preferred embodiment of the present invention;

FIG. 18 is a top cross-sectional view of the clamp applier of the secondpreferred embodiment of the present invention;

FIG. 19 is a top cross-sectional view of both the surgical clamp and theclamp applier of the second preferred embodiment of the presentinvention;

FIG. 20 is a side cross-sectional view of the surgical clamp and theclamp applier of the second preferred embodiment of the presentinvention;

FIG. 21 is a cross-sectional view taken along line 21--21 of FIG. 20;

FIG. 22 is a side view of the pivoting arm and actuator spring of theclamp applier of the second embodiment of the present invention; and

FIGS. 23-25 show the surgical clamp and the clamp applier of the secondpreferred embodiment in three sequential configurations.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

A surgical clamp and clamp applier are illustrated in FIG. 1 anddesignated respectively by the reference numerals 10 and 12. The clamp10 has a generally cylindrical configuration with an axis 14 extendingbetween a proximal end 16 and a distal end 18.

The clamp applier 12 includes a housing 21 and a tube 23 which extendsdistally of the housing 21 along an axis 25. The tube 23 and the clamp10 are sized and configured to fit through a trocar 27 which has beenpositioned to provide access across the lapra or abdominal wall 30. Boththe trocar 27 and the laparoscopic surgical procedure are described ingreater detail in applicant's U.S. Pat. No. 5,209,737 issued on May 11,1993 and entitled Lever Actuated Septum Seal.

Within the abdominal cavity, the clamp applier can be operated to openand close the clamp 10 about a body conduit, such as a bowel 32. Oncethe clamp 10 is attached to the bowel 32 it can function not only toocclude but also to cooperate with a retractor to move the bowel to anew location within the abdominal cavity.

In FIG. 2, the clamp 10 is illustrated in an axial cross-section view toinclude a supporting structure 34 and a pair of jaws 36 and 38. In theillustrated embodiment, the jaw 36 is formed as an extension of thesupporting structure 34, while the jaw 38 is pivotal on the jaw 36 at ahinge 41.

The jaws 36 and 38 extend longitudinally toward the distal end 18 of theclamp 10 where one of the jaws, such as the jaw 38 is provided with anoverhang 43. As the jaw 38 moves into proximity with the jaw 36, theoverhang 43 encloses the bowel 32 prior to complete occlusion. Thisinsures that the bowel 32 is captured between the jaws 36, 38 as thefinal occluding pressure is applied.

At the proximal end of the jaw 38, distally of the supporting structure34, the jaw 38 is provided with a beveled surface 45 which facesinwardly toward the axis 14 of the clamp 10. This surface 45 functionsin a camming action with a screw 47 which is rotatable within thesupporting structure 34. In the preferred embodiment, the screw 47 isdisposed for movement along the axis 14 of the clamp 10. As the screw 47is rotated it moves axially through the supporting structure 34 toengage the beveled surface 45. Further axial movement of the screw 47forces the jaw 38 to pivot on the hinge 41. This pivotal movement movesthe jaw 38 from an open state illustrated in FIG. 2, wherein the jaw 38is spaced from the jaw 36, to a closed state illustrated in FIG. 1wherein the jaw 38 is brought into proximity with the jaw 36. In theclosed state, the body conduit, such as the bowel 32, which is disposedbetween the jaws 36 and 38, is at least partially occluded. Soft inserts49 can be provided along the jaws 36 and 38 to reduce trauma to thebowel 32.

A spring 52 can be provided in the hinge 41 in order to bias the jaws 36and 38 to the open position. When the screw 47 is retracted, the jaw 38will automatically separate from the jaw 36. When the screw 47 isadvanced, the jaw 38 moves toward the jaw 36 against the bias of thespring 52. In an alternative embodiment (not shown), both of the jaws 36and 38 are pivotal along the supporting structure 34 and include bevelsurfaces, such as surface 45, which are engagable by the screw 47 toopen and close the jaws 36, 38.

At the proximal end of the screw 47, an annulus 54 can be provided inorder to facilitate attachment to the clamp applier 12. The annulus 54preferably has an axis 55 which perpendicularly intersects the axis 14of the clamp 10.

The clamp applier 12 is illustrated in the axial cross-section view ofFIG. 3 which shows the interior regions of the housing 21 and the tube23. The tube 23 is attached to the distal end of the housing 21 where adistal wall 56 extends generally perpendicular to the axis 25.

A shaft 58 extends through the tube 23 and proximally through a hole 61in the distal wall 56 into the housing 21. Within the housing 21, theshaft 58 extends through a wafer 62 and terminates in the distal end ofan aladdin screw 63. At its proximal end, the diameter of the aladdinscrew 63 is decreased to define a proximal facing shoulder 65, increasedto define a distally facing shoulder 67, and enlarged again at adistally facing shoulder 69 formed on a terminal lug 70. The aladdinscrew 63 has an outer cylindrical surface which is provided withcounter-rotating spiral grooves 72 and 74.

A trigger 81 pivotal on the housing 21 operates a pair of fingers 83 and85. These fingers are closely spaced to receive the reduced diameter ofthe aladdin screw 63 between the shoulders 65 and 67. A handle 90 fixedto the housing 21 provides support, in the palm of a user's hand (notshown), against which the trigger 81 can be operated. Pulling thetrigger causes the fingers 83, 85 to engage the proximally facingshoulder 65 and to move the aladdin screw 63 and associated shaft 58distally as illustrated in FIG. 4.

With the wafer 62 fixed to the shaft 58 and the wall 56 fixed to thehousing 21, a compression spring 92 disposed therebetween around theshaft 58 functions to bias the aladdin screw 63 and shaft 58 toward aproximal retracted position. This proximal position is illustrated inFIG. 3 along with a locking mechanism which functions to maintain thescrew 63 and the shaft 58 in the proximal position. The lockingmechanism includes a second trigger 96 and a pair of fingers 98 and 101which engage the aladdin screw between the shoulders 67 and 69. In apreferred embodiment, these fingers 98, 101 extend perpendicular to theaxis 25 and abut the distally facing shoulder 69 to hold the terminallug 70 in a locked proximal position. When the trigger 96 is in a distalposition, spaced from the handle 90, the aladdin screw 63 and shaft 58are locked in the proximal position. When the trigger 96 is pulledagainst the handle 90 as illustrated in FIG. 4, the fingers 98 and 101are removed from the terminal lug 70 to permit distal movement of thescrew 63 and shaft 58. When both of the triggers 81 and 96 are movedagainst the handle 90, the trigger 96 initially releases the lock as thetrigger 81 deploys the screw 93 and shaft 58 to the distal extendedposition.

The proximal and distal positions of the shaft 58 are best describedwith reference to the distal end of the shaft 58 which is formed in theshape of a hook 110. In a preferred embodiment, the distal end of thehook 110 includes a terminal portion 112 which extends generallyperpendicular to the axis 25. The hook 110 is sized and configured toengage the annulus 54 at the proximal end of the clamp 10. Thus the hook110 and shaft 58 function as an engagement mechanism for initiallyengaging the clamp 10 and ultimately moving the clamp into operativedisposition relative to the tube 23.

The trigger 81 functions to deploy this engaging mechanism to the distalposition wherein the hook 110 extends beyond the end of the tube 23. Inthis position the terminal end 112 of the hook 110 is accessible forinsertion into the annulus 54. In FIG. 6, the clamp 10 is illustrated ina free state wherein it is not attached to the clamp applier 12. Oncethe hook 110 engages the annulus 54 and the trigger 81 is released,however, the spring 92 functions to move the shaft 58 and hook 110 tothe proximal position drawing the annulus 54 of the clamp 10 into thetube 23. In a preferred embodiment, this brings the clamp 10 intoabutting relationship with the distal end of the tube 23 wherein theaxes 14 and 25 are aligned to facilitate insertion through the trocar27.

It will be apparent that the clamp 10 can be otherwise engaged by theshaft 58 of the applier 12 in a locking but operative position. Ingeneral, the screw 47 needs to be positively engaged by the shaft 58 sothat the clamp 10 cannot be accidentally dropped into the abdominalcavity. This positive engagement between the clamp 10 and shaft 58 mustalso be capable of transmitting the rotational movement of the shaft 58to the screw 47.

In this operative position, the supporting structure 34 of the clamp 10can be held against axial movement by the locking mechanism includingthe trigger 96. The supporting structure of the clamp 10 is held againstrotational movement relative to the tube 23 by a key 114 on thesupporting structure 34 and associated key way 116 on the tube 23. In apreferred embodiment, the key 114 is formed with four sides which areequally spaced around and inclined proximally toward the axis 14. Thiskey 114 registers with similar surfaces which are formed on the insideof the tube 23 and define the key way 116. At the base of the key 114,the supporting structure 34 forms a proximally facing shoulder 118, bestillustrated in FIG. 2. This shoulder 118 is adapted to register with adistal surface 121 on the tube 23. Other configurations for the key 114and key way 116 will be apparent. In general, it is desirable that thekey 114 can be tapered inwardly, proximally in order to achieve axialalignment of the clamp 10 and tube 23. Any noncircular shape for the key114 and key way 116 would appear to inhibit rotational movement betweenthe clamp 10 and tube 23.

When the clamp 10 is operatively disposed, the annulus 54 is engaged bythe hook 110 interiorly of the tube 23. The key 114 registers with thekey way 116, and the shoulder 118 is in abutting relationship with thesurface 121. With the proximal bias on the shaft 58, the clamp 10 isautomatically moved to this operative position where it can be locked inplace by operation of the trigger 96.

Once the clamp 10 is operatively disposed at the distal end of the clampapplier 12, it will normally be desirable to operate the screw 47 inorder to open and close the jaw 38. This rotation of the screw 47 isaccomplished in a preferred embodiment by rotating the shaft 58. Forexample, as illustrated in FIG. 3, a second handle 130 can be providedon the housing 21 for engagement by the fingers of a user's hand. Thishandle is fixed to a follower block 132 which is movable along thehousing 21 in cooperation with the aladdin screw 63. This follower block132 includes a follower 133 movable between two positions by operationof a tab 134 which is accessible outside the housing 21.

In accordance with the normal operation of an aladdin screw, the tab 134is operable to bring the follower 133 into registration with one of thegrooves 72 and 74. When the follower 133 engages the groove 74 forexample, movement of the handle 130 toward the handle 90 causes thealaddin screw 63 to rotate in a clockwise direction. This causes theshaft 58 to rotate in a clockwise direction and to advance the screw 47of the clamp 10 toward the beveled surface 45. When the tab 134 isoperated to move the follower into engagement with the groove 72,movement of the handle 130 toward the handle 90 rotates the aladdinscrew 63 in a counter-clockwise direction. This causes the shaft 58 tomove counter-clockwise and the screw 47 to be withdrawn from the beveledsurface 45 permitting the jaws 36, 38 to open.

Thus the aladdin screw 63 and associated follower 133, tab 134 andhandle 130 function so that the linear movement of the handle 130 isconverted into rotational movement of the shaft 58. In this particularembodiment, movement of the handle 130 in a single direction, toward thehandle 90, can produce either clockwise or counter-clockwise rotation ofthe shaft 58 depending on the position of the tab 134 and associatedfollower 133.

In a preferred method associated with the invention, the clamp 10 isinitially in a free state, unattached to the clamp applier 12. In orderto prepare the applier 12 to receive the clamp 10, the shaft 58initially must be unlocked. This requires that the trigger 96 be pulledagainst the handle 20 in order to remove the fingers 98, 101 from theshoulder 69 of the terminal lug 70. Thus operation of the trigger 96elevates the fingers 98, 101 as illustrated in FIG. 4, to free the shaft58 for axial movement along the axis 25.

In this unlocked state, the shaft 58 is biased in the retracted positionso that operation of the trigger 81 is required to deploy the hook 110.By pulling the trigger 81 against the handle 90, the fingers 83, 85 arebrought into engagement with the shoulder 65. Further proximal movementof the trigger 81 moves the aladdin screw 63 and shaft 58 against thebias of the spring 92 to the extended position illustrated in FIG. 4.

In this extended position, the terminal end 112 of the hook 110 can beintroduced through the annulus 54 to engage the clamp 10. When thetrigger 81 is released, the bias of the spring 92 moves the shaft andaladdin screw 63 toward the retracted position. The hook 110 is drawninto the tube 23 along with the annulus 54, and the key 114 on the clamp10 registers with the key way 116 at the distal end of the tube 23. Whenthe shoulders 118 abut the distal surface 121, the clamp 10 has achievedits operative position. It can be retained in this position by movingthe trigger 96 distally so that the fingers 98, 101, engage the shoulder69 on the terminal lug 70.

In this operative position, registration of the key 114 and key way 116seeks to align the axis 14 of the clamp 10 with the axis 25 of the clampapplier 12. Axial movement of the clamp 10 relative to the applier 12 isinhibited by the locking mechanism, while rotational movement of theclamp 10 relative to the applier 12 is inhibited by the registration ofthe key 114 and key way 116. In this operative position, the shaft 56can be rotated in two directions to either open or close the jaws 36,38.

In an embodiment including the aladdin screw 63, operation of the handle130 in a single direction, for example toward the handle 90, can causerotation of the shaft 58 in either of the two directions. For example,if the tab 134 is positioned so that the follower 133 engages the groove74, movement of the handle 130 toward the handle 90 will be convertedinto clockwise rotation of the shaft 58. This will cause the screw 47 toadvance into the beveled surface 45 causing the jaws 36 and 38 asillustrated in FIG. 9. Alternatively, with the tab 134 disposed in theopposite position, the follower 133 engages the groove 72 of the aladdinscrew 63. Then, movement of the handle 130 toward the handle 90 can beconverted into rotational movement of the shaft 58 in thecounter-clockwise direction. This will remove the screw 47 from thebeveled surface 45 resulting in separation of the jaws 36, 38 byoperation of the spring 52, as illustrated in FIG. 10.

While the aladdin screw 63 is incorporated in a preferred embodiment, itwill be apparent that a single screw could also be used. In such anembodiment, operation of the handle 130 toward the handle 90 couldresult in the clockwise rotation of the shaft 58 while movement of thehandle 130 away from the handle 90 would result in counter-clockwiserotation of the shaft 58.

The foregoing apparatus and method are of particular interest in asurgical procedure providing for removal of a section of the bowel 32.This procedure is illustrated in FIGS. 11-14 wherein three sections ofthe bowel are designated consecutively by the reference numerals 32a,32b and 32c. In this procedure, it is the center section 32b which is tobe removed.

Initially a clamp 10a is engaged by the clamp applier 12 and insertedthrough the trocar 25 to operatively occlude the bowel between thesection 32a and 32b. After the clamp 10a has been operativelypositioned, the applier 12 can be operated to disengage the hook 110from the associated annulus 54a. Then a second clamp 10b is operativelydisposed to occlude the bowel between the section 32b and the section32c. After the clamp 10b has been positioned, the clamp applier 12 canbe operated to release the hook 110 from the associated annulus 54b.

At this point it may be desirable to elevate the bowel 32 in order toprovide better access within the abdominal cavity. For this purpose,retractors 136 and 138 can be introduced through the abdominal wall 30to engage the respective annulus 54a and 54b. Alternatively, theretractors 136, 138 can be introduced through secondary trocars (notshown) similar to the trocar 25. Once the clamps 10a and 10b have beenengaged by the respective retractors 136, 138, they can be moved towardthe abdominal wall 30 to elevate the bowel 32 as illustrated in FIG. 12.

In this elevated location, two additional clamps 10c and 10d can beattached to occlude the bowel 32 adjacent the respective clamps 10a and10b. These clamps 10c and 10d can also be released and the clamp applier12 removed from the trocar 25.

With the clamps 10a-10d appropriately positioned, the center section 32bof the bowel 32 can be severed from the sections 32a and 32c byappropriate incisions between the clamp pairs 10a, 10c and 10d, 10b. Atthis point, the clamp applier 12 can be reinserted through the trocar 25to engage the clamps 10c and 10d and to remove these clamps through thetrocar 25. A grasper 141 may also be inserted to withdraw the centralsection 32b of the bowel, as illustrated in FIG. 13. Finally, a suturingmechanism (not shown) can be introduced through the trocar 12 tofacilitate the placement of sutures 143 between the bowel portion 32a tothe bowel portion 32c.

At the completion of this step, the retractors 136, 138 can be operatedto disengage the clamps 10a, 10b, and the clamp applier 12 can bereintroduced to retrieve the clamps 10a, 10b. Ultimately the retractors136, 138 and the trocar 25 are removed from the abdominal wall 30 tocomplete the procedure.

A second preferred embodiment of the clamp is illustrated in FIGS.15-25. With initial reference to FIGS. 15, 18, and 19, the surgicalclamp 208 comprises a first jaw 212 and a second jaw 214. The first jaw212 and the second jaw 214 preferably comprise injection molded plastic.The surgical clamp 208 comprises a proximal end near an annulus 216, adistal end opposite the annulus 216, and a clamp axis 232 extendingbetween the proximal end and the distal end. Similarly to the embodimentof the clamp 10 described above with reference to FIG. 2, the annulus216 of the surgical clamp 208 is adapted for accommodating a hook 218(FIG. 18). The hook 218 pulls the proximal portion of the surgical clamp208 into contact with a tube 223 (FIG. 18), which preferably comprisesstainless steel and is similar to the tube 23 shown in FIG. 1, forexample. A wedge 225 (FIG. 19) of the surgical clamp 208 moves intocontact with an incline 227 (FIG. 18), which is disposed within the tube223. The close fit between the wedge 225 and the incline 227 serves toalign an axis 230 (FIG. 18) of the tube 223 with the clamp axis 232 and,further, prevents the surgical clamp 208 from rotating about either ofthese axes 230 and 232.

The first jaw 212 comprises a slot 234, which is formed between a fixedmember 235 and a movable member 236. A pawl/spring assembly 237 issecured to the fixed member 235 via a first fastener 238, and themovable member 236 is secured to the first jaw 212 via a pivot 239. Aspresently embodied, the fixed member 235 is integrally formed with thefirst jaw 212. The first fastener 238, in combination with the integralholding member 241, firmly hold a base 243 of the pawl/spring assembly237 to the first jaw 212. A leaf spring 244, however, allows the pawl245 to move in and out of mesh with a ratchet 247 of the second jaw 214.As presently embodied, the pawl 245 is biased into mesh with the ratchet247, but can be moved against this bias out of mesh with the ratchet247. As presently preferred, the movement of the pawl 245 approximates apivoting movement about the leaf spring 244, but other engaging anddisengaging motions may also be used.

The movable member 236, which is secured to the first jaw 212 via thepivot 239, comprises a contacting protrusion 250. The contactingprotrusion 250 is preferably integrally formed with the movable member236, and is adapted to contact a receptor protrusion 251 of the pawl245. Rotational movement of the movable member 236 about the pivot 239in a counter-clockwise direction results in the contacting protrusion250 moving the pawl 245 against the bias of the leaf spring 244 via thereceptor protrusion 251. Movement of the pawl 245 against the bias ofthe leaf spring 244 results in disengagement of the pawl 245 from theratchet 247.

FIG. 16 shows the first jaw 212 disassembled from the second jaw 214.The first jaw 212 is pivotally held to the second jaw 214 with a snapprotrusion 240 of the first jaw 212 that fits into a snap aperture 242of the second jaw 214. As can best be seen with reference to FIG. 16,the teeth of the fixed ratchet 247 are slanted in a clockwise direction.The teeth of the pawl 245 of the first jaw 212 are also slanted in aclockwise direction. This orientation of the teeth of the fixed ratchet247 and of the pawl 245 allows the two sets of teeth 245 and 247 toslide upon one another when the first jaw 212 is moved toward the secondjaw 214, but does not allow the two sets of teeth 245 and 247 to slideupon one another when the first jaw 212 is moved away from the secondjaw 214. Thus, this slanting of the teeth 245 and 247 allows the twojaws 212 and 214 to be shut, but does not allow the two jaws 212 and 214to be opened.

If a force is applied to the distal end 245 of the movable member 236 tothereby exert a counter-clockwise rotational force on the movable member236 about the pivot 239, then the movable member 236 will rotate in acounter-clockwise direction. This rotation of the movable member 236moves the contacting protrusion 250 against the receptor protrusion 251,to thereby move the pawl 245 toward the base 243 and out of mesh withthe ratchet 247. Accordingly, counter-clockwise rotational movement ofthe movable member 236 results in the pawl 245 being moved out of meshwith the ratchet 247. As presently embodied, any force applied to thedistal end 245 should be in a general direction of the arrow A1. Furtherrotational movement of the movable member 236 continues to hold the pawl245 out of mesh with the ratchet 247 and, additionally, results inmovement of the first jaw 212 away from the second jaw 214.

In the presently preferred embodiment, a pin 254 (FIG. 18) fits withinthe slot 234. Movement of the pin 254 within the slot 234 in thedirection of the arrow A1 results in the pin 254 contacting the movablemember 236. This application of force by the pin 254 onto the movablemember 236 results in disengagement of the pawl 245 and, subsequently,upon further force by the pin 254, results in movement of the first jaw212 away from the second jaw 214. Movement of the pin within the slot234 against the proximal end 251 of the movable member 236 results inthe movable member 236 rotating in a clockwise direction to thereby movethe contacting protrusion 250 away from the receptor protrusion 251.When the pin 254 is moved against the proximal end 255 of the fixedmember 235, the first jaw 212 moves toward the second jaw 214, as theteeth of the pawl 245 and the ratchet 247 slide upon one another. Thus,according to the present invention, movement of a single pin 254 withinthe slot 234 functions to open and close the surgical clamp 208.

FIG. 17 illustrates a clamp applier 210, which is used in conjunctionwith the surgical clamp 208. The clamp applier 210 comprises the axis230, which extends between a proximal end of the clamp applier 210 nearthe movable handle 270 and a distal end of the clamp applier 210 near apivoting arm 272. FIG. 18 illustrates a top view of the clamp applier210. In operation, a user moves the trigger 256 in the proximaldirection toward the stationary handle 258, which is preferablyintegrally molded with the housing 257. The trigger 256 rotates in acounter-clockwise direction about the first hinge 261, and causes theshaft 263 and the hook 218 to move forward in the distal direction.

The hook 218 is first inserted through the annulus 216 of the surgicalclamp 208. Next, the user releases the trigger 256 which causes thespring-biased hook 218 to be retracted back into the tube 223. As theproximal end of the surgical clamp 208 is pulled into the tube 223, thewedge 225 of the surgical clamp 208 moves into contact with the incline227.

The top view shown in FIG. 19 illustrates the registering of the wedge225 of the surgical clamp 208 with the incline 227 of the clamp applier210. The close fit between the wedge 225 and the incline 227 serves toalign the axis 230 of the clamp applier 210 with the clamp axis 232 and,further, prevents the surgical clamp 208 from rotating about either ofthese axes 230 and 232. A side view of the surgical clamp 208 and theclamp applier 210 of FIG. 19 is shown in FIG. 20.

As the wedge 225 of the surgical clamp 208 is drawn into contact withthe incline 227 of the clamp applier 210, the pin 254 of the clampapplier 210 is automatically positioned within the slot 234. A crosssection taken along the line 21--21 of FIG. 20 is shown in FIG. 21. Thepin 254 initially fits within the slot 234, or comes into contact withone of the two ramps 264 disposed on opposite sides of the slot 234. Oneof the ramps 264 comprises a surface of the fixed member 235 and otherramp comprises a surface of the movable member 236. If the pin 254initially contacts one of the two ramps 264, then further movement ofthe surgical clamp 208 by the hook 218 causes the pin 254 to travel upthe ramp 264 and into the slot 234. Since the actuator spring 278 isflexible in a direction normal to the channel 283 of the pivoting arm271, as shown in FIG. 22, movement of the pin 254 up the ramp 264 doesnot break or damage the actuator spring 278.

A rod 265 connects the pivoting arm 272 to the movable handle 270. Thestationary handle 258 and the movable handle 270 together comprise a setof scissor handles, which is easy to operate with a single hand of theuser. The user can move the movable handle 270 toward and away from thestationary handle 258 with ease.

The pivoting arm 272, which is pivotal in a vertical plane about a pivothinge 276, has an actuator spring 278 secured thereto. The actuatorspring 278 is secured to the pivoting arm 272 with a single screw 281.In the presently preferred embodiment, the actuator spring 278 comprisesa leaf spring, which fits into a channel 283 of the pivoting arm 272.The channel 283 of the pivoting arm 272 prevents the actuator spring 278from moving in the vertical plane, except for when the pivoting arm 272is also moved in the vertical plane.

Since the actuator spring 278 is only secured to the channel 283 at theproximal end of the actuator spring 278, the actuator spring 278 is ableto move slightly in a horizontal plane, which passes through the channel283. Thus, the distal end of the actuator spring 278 is able to moveaway from the channel 283, but the proximal end of the actuator spring278 is secured to the channel by the single screw 281. The positioningof the actuator spring 278, after movement away from the channel 283, isshown in phantom in FIG. 22 and denoted by the reference number 285. Asthe pivoting arm 272 is pivoted about the pivot hinge 276, the actuatorspring 278 also pivots about the pivot hinge 276. The actuator spring278 remains in or directly above the channel 283 of the pivoting arm 272during this movement.

Referring now to FIGS. 23-25, when the movable handle 270 is moved inthe forward direction by counter-clockwise rotation of the movablehandle 270 about the second hinge 287, the rod 265 is moved distally inthe direction of the arrow A2. The distal movement of the rod 265results in rotation of the pivoting arm 272 in the counter-clockwisedirection (clockwise direction in FIG. 17) about the pivot hinge 276.This rotation of the pivoting arm 272 causes the proximal portion of thepivoting arm 272, which is connected to the rod 265, to move downwardand to issue through a slot in the tube 223. Alternatively, the tube 223may be configured to surround only the incline 227 and the shaft 263,but not the pivoting arm 272 and the actuator spring 278. As the rod 265rotates the pivoting arm 272, a distal end 273 of the rod 265 travelswithin a track 275. The track 275 facilitates rotation of the pivotingarm 272 by the rod 265, without requiring the rod 265 to bend, forexample.

FIG. 24 illustrates the distal end 273 of the rod 265 in an intermediateportion of the track 275, corresponding to an intermediate orientationof the pivoting arm 272. Referring briefly back to FIG. 23, an initialrotation of the pivoting arm 272 in the counter-clockwise directionresults in movement of the movable member 236 in a counter-clockwisedirection about the pivot 239. The movable member 236 is thus moved froman initial first configuration, shown in FIG. 23, to a secondconfiguration where the first jaw 212 and the second jaw 214 are stillclosed but the pawl 245 is no longer in mesh with the ratchet 247.

Further movement of the rod 265 in the distal direction results infurther rotational movement of the pivoting arm 272 and, consequently,results in further rotational movement of the movable member 236. FIG.24 illustrates the rotational movement of the movable member 236, wherethe pawl 245 is no longer in mesh with the ratchet 247, and where thefirst jaw 212 and the second jaw 214 are somewhat opened. The movablemember 236 is shown in FIG. 24 in the third configuration, where thefirst jaw 212 and the second jaw 214 are opened.

In FIG. 25, the first jaw 212 and the second jaw 214 are shown in acompletely open position, which comprises 35 degrees in the presentlypreferred embodiment. In this completely open configuration, the pin 254has moved from the distal end 245 (FIG. 23), to an intermediate locationbetween the distal end 245 and the proximal end 251 (FIG. 24), andfinally to the proximal end 251 of the movable member 236. Movement ofthe pin 254 to the proximal end 251 of the movable member 236 applies arotational force onto the movable member 236, to thereby rotate themovable member 236 back into the first configuration, where the teeth ofthe pawl 245 are in mesh with the teeth of the ratchet 247.

When the movable handle 270 is moved in the reverse direction byclockwise rotation of the movable handle 270 about the second hinge 287,on the other hand, the rod 265 is moved in a proximal direction.Subsequent movement of the rod 265 in the proximal direction results inmovement of the first jaw 212 and the second jaw 214 together, as theteeth of the pawl 245 slide against the teeth of the ratchet 247. Thus,proximal movement of the rod 265 results in rotation of the pivoting arm272 in the counter-clockwise direction about the pivot hinge 276, whichcauses the pin 254 of the actuator spring 278 to move in a downwarddirection. This downward movement of the pin 254 results in movement ofthe first jaw 212 toward the second jaw 214. The surgical clamp 208 andclamp applier 210 can be used similarly to the surgical clamp 10 andclamp applier 12, as discussed above with reference to FIGS. 11-14, forexample.

In the foregoing discussion, several preferred embodiments andassociated methods have been described. Many variations on this conceptwill now be apparent. For example, many clamp configurations can beadapted to provide a generally cylindrical configuration with jawsopenable and closeable by operation of a mechanism generally along theaxis of the clamp, or by movement of a mechanism in a direction normalto the axis of the clamp. With these constraints, the clamp can beintroduced through a trocar to facilitate a wide variation inlaparoscopic procedures.

Both apparatus and methods for operating such a clamp with anappropriate clamp applier will also be apparent. Initially the appliermust have an elongate configuration also sized and configured to fitthrough a trocar. An appropriate mechanism for holding the clamp in afixed operable position will be desirable. Once the clamp is in thisposition, an appropriate mechanism will open and close the jaws of theclamp.

Given the wide variation in the possibilities for embodying theseconcepts, one is cautioned not to determine the scope of the inventionmerely with reference to the drawings and associated description, butrather with reference to the follow claims.

Although exemplary embodiments of the invention have been shown anddescribed, many other changes, modifications and substitutions, inaddition to those set forth in the above paragraph, may be made by onehaving ordinary skill in the art without necessarily departing from thespirit and scope of this invention.

I claim:
 1. A surgical clamp, comprising:a first jaw having a proximalend and a distal end; a movable set of teeth disposed near the proximalend of the first jaw and having a movable relationship with the firstjaw; a second jaw having a proximal end and a distal end and a pivotalrelationship with the first jaw; a fixed set of teeth disposed near theproximal end of the second jaw and having a fixed relationship with thesecond jaw; and a movable member disposed in proximity to the first jawand configured for contacting and moving the movable set of teeth in andout of mesh with the fixed set of teeth, the movable member havingproperties for moving the first jaw and the second jaw between an openstate wherein the distal end of the first jaw is spaced from the distalend of the second jaw to accept a body conduit, and a closed statewherein the distal end of the first jaw and the distal end of the secondjaw are proximate to at least partially occlude the body conduit.
 2. Thesurgical clamp as recited in claim 1, the movable member comprising acontacting protrusion configured for contacting a receptor protrusion ofthe movable set of teeth, upon reception of a force from an externaldevice.
 3. The surgical clamp as recited in claim 2, the first jaw andthe second jaw being rotationally secured together near the movable setof teeth and the fixed set of teeth, and the movable member beingpivotally secured to the first jaw.
 4. The surgical clamp as recited inclaim 3, the movable member and the first jaw together forming a slotnear the proximal end of the first jaw; andthe external devicecomprising a pin configured to fitting within the slot, whereinapplication of a force within the slot by the pin in a first directionmoves the first jaw and the second jaw to the open state, and whereinapplication of a force within the slot by the pin in a second directionmoves the first jaw and the second jaw to the closed state.
 5. Thesurgical clamp combination as recited in claim 4, the slot comprisingtwo ramps disposed on opposing sides of the slot.
 6. The surgical clampas recited in claim 4, the first jaw comprising a first member that isintegrally formed with the first jaw,the movable set of teeth beingpivotally disposed on the first member, and the movable member beingconfigured for moving the movable set of teeth in and out of mesh withthe fixed set of teeth by contacting the receptor protrusion of themovable set of teeth.
 7. The surgical clamp as recited in claim 6, thepin being configured for applying a force on the movable member tothereby move the movable set of teeth out of mesh with the fixed set ofteeth, and, subsequently, to move the first jaw and the second jaw tothe open state.
 8. The surgical clamp as recited in claim 7, the movableset of teeth being pivotally disposed on the first jaw via a leafspring.
 9. The surgical clamp as recited in claim 1, the movable set ofteeth comprising a pawl, andthe fixed set of teeth comprising a ratchet.10. A surgical clamp, comprising:two jaws movable relative to each otherbetween an open position and a closed position; a ratchet and pawlassembly connected to the two jaws and adapted for allowing relativerotational movement of the two jaws when the jaws are moved relative toeach other in a first direction and preventing relative rotationalmovement of the two jaws when the jaws are moved relative to each otherin a second direction; and a movable member disposed in proximity to thejaws and having properties for contacting the pawl to disengage the pawlfrom the ratchet in order to permit relative rotational movement of thetwo jaws in the second direction.
 11. A surgical clamp combination,comprising:a pair of jaws forming a surgical clamp, the jaws beingmovable between an open position and a closed position; a ratchet andpawl assembly connected to the surgical clamp, the pawl being biasedinto a mesh relationship with the ratchet, the ratchet and pawl assemblybeing adapted for permitting relative movement of the pair of jaws in afirst rotational direction and for preventing relative movement of thepair of jaws in a second rotational direction; a pawl-removing memberdisposed in proximity to the jaws and having properties for contactingand removing the pawl from the mesh relationship with the ratchet, tothereby allow for relative movement of the pair of jaws in the secondrotational direction; a clamp applier having a longitudinal axisextending between a proximal end and a distal end; a tube disposed atthe distal end of the clamp applier; engaging means disposed within thetube for engaging the surgical clamp; and operating means disposed atthe proximal end of the clamp applier for operating the engaging meansto activate the pawl-removing member to thereby facilitate movement ofthe pair of jaws in the second rotational direction.
 12. The surgicalclamp combination as recited in claim 11, the surgical clamp comprisingan annulus, andthe engaging means comprising a hook and a pin, the hookbeing adapted to be placed within the annulus and the pin being adaptedto contact the pawl-removing means.
 13. The surgical clamp combinationas recited in claim 12, the surgical clamp comprising a slot foraccommodating the pin, the slot having ramps on opposing sides thereof,movement of the pin in a first pin direction causing the pair of jaws tomove in the first rotational direction, and movement of the pin in asecond pin direction contacting the pawl-removing means and causing thepair of jaws to move in the second rotational direction.
 14. Thesurgical clamp combination as recited in claim 13, the operating meanscomprising a trigger for operating the hook and a handle for operatingthe pin, andthe handle comprising a scissor handle, having onestationary piece and one movable piece.
 15. The surgical clampcombination as recited in claim 14, further comprising:a pivoting armdisposed at a distal end of the tube, the pivoting arm having the pinattached thereto; and an actuator spring connected to the pivoting arm,the actuator spring accommodating the pin at a distal end of theactuator spring, the actuator spring being adapted for pivoting with thepivoting arm, the actuator spring being bendable in a directionapproximately normal to the pivoting arm to facilitate movement of thepin on one of the ramps.
 16. The surgical clamp combination as recitedin claim 15, movement of the movable piece of the scissor handle in afirst handle direction rotating the pivoting arm disposed at the end ofthe tube in a first rotational direction to thereby move the pin in thefirst direction, andmovement of the movable piece of the scissor handlein a second handle direction rotating the pivoting arm disposed at theend of the tube in a second rotational direction to thereby move the pinin the second pin direction.
 17. A surgical clamp having a longitudinalconfiguration and an axis extending between a proximal end and a distalend of the surgical clamp, the clamp comprising:a first jaw having afirst set of slanted teeth disposed near the proximal end; a second jawhaving a second set of slanted teeth, the two sets of teeth being biasedinto mesh with one another, the two sets of teeth when in mesh beingadapted to slide upon one another to thereby allow the first jaw topivot roughly about the proximal end in a first direction, the two setsof teeth wherein mesh not allowing the first jaw to pivot roughly aboutthe proximal end in a second direction; and a movable member having aconfiguration facilitating contact with at least one of the two sets ofteeth to move the two sets of teeth out of mesh, movement of the twosets of teeth out of mesh allowing the first jaw to pivot relative tothe second jaw in the second direction.
 18. A surgical clampcombination, comprising:a surgical clamp having a longitudinal axisextending between a proximal end and a distal end, and including asupporting structure; first and second jaws coupled to the supportingstructure, the jaws being movable between an open position and a closedposition; a movable member carried by the supporting structure andoperable between a first configuration where a pawl of the first jaw isbiased into mesh with a ratchet of the second jaw, a secondconfiguration where the pawl is not biased into mesh with the ratchet,and a third configuration where the first and second jaws can be movedbetween both the open position and the closed position; a clamp applierhaving a longitudinal axis extending between a proximal end and a distalend; a tube disposed at the distal end of the clamp applier; engagingmeans disposed within the tube for engaging the movable member at theproximal end of the clamp and for moving the movable member between thethree configurations; and operating means disposed at the proximal endof the clamp applier for operating the engaging means to move the jawsof the clamp.
 19. A surgical clamp, comprising:a first jaw having aproximal end and a distal end; a pawl secured to the first jaw near theproximal end, the pawl being biased in a proximal direction via a leafspring; a second jaw having a proximal end and a distal end, and adaptedfor being pivotally secured to the first jaw, the second jaw comprisinga ratchet, which is disposed proximally relative to the pawl and in meshwith the pawl when the second jaw is secured to the first jaw; and amovable member secured to the first jaw, the movable member beingadapted for contacting and moving the pawl in a distal direction againstthe bias of the leaf spring to thereby move the pawl out of mesh withthe ratchet, the first jaw and the second jaw being movable from aclosed state to an open state when the pawl is moved in the distaldirection by the movable member, the pawl being biased back into meshwith the ratchet when the movable member is removed from contact withthe pawl.
 20. The surgical clamp as recited in claim 19, the movablemember being adapted for moving from a first configuration into a secondconfiguration in order to move the pawl in the distal direction, and themovable member being adapted for subsequently moving from the secondconfiguration into a third configuration in order to move the first jawand the second jaw from the closed state to the open state.
 21. Thesurgical clamp as recited in claim 20, the movable member being adaptedfor moving from the third configuration back into the firstconfiguration in order to move the first jaw and the second jaw from theopen state to the closed state.